Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping

Abstract

BackgroundWe aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life.MethodsWe used intervention mapping to guide the development of our intervention. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention.ResultsThe Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the “Heart Failure Manual”, a choice of two exercise programmes for patients, a “Family and Friends Resource” for caregivers, a “Progress Tracker” tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas, especially in terms of addressing caregivers’ needs. The REACH-HF materials were revised accordingly.ConclusionsWe have developed a comprehensive, evidence-informed, theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers. A randomised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0075-x) contains supplementary material, which is available to authorized users.

Involving caregivers in self‐management interventions for patients with heart failure and chronic obstructive pulmonary disease. A systematic review and meta‐analysis

“…They posit that intervention development should be aimed at dyads. Cho One example of comprehensive intervention development is the approach used in developing an evidence-based self-management intervention for HF patients and their caregivers (Greaves et al, 2016). Using intervention mapping and eliciting and synthesizing information from a multitude of sources they produced the rehabilitation enablement in chronic heart failure intervention (REACH-HF).…”

Patients with heart failure with preserved ejection fraction and their caregiver’s experiences of home-based rehabilitation (REACH-HFpEF): mixed methods process evaluation of the REACH-HFpEF single centre pilot randomised controlled trial.

“…The REACH-HF intervention is a comprehensive 12-week practitioner facilitated self-care support programme co-designed with HF patients, caregivers, and healthcare professionals [12]. It comprises:…”

“…Facilitator interactions with participants were audio recorded and the quality of delivery assessed using a 13-item checklist previously developed by the research team [12,13]. Scoring ranged from 0 -'an absence or very poor delivery' to 6 -'excellent/expert use of techniques for each (predefined) key component of the intervention process.…”

“…However, given the suboptimal uptake of CR in people with HF, there is a need for alternative models of CR delivery, including home-based interventions [11]. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a healthcare professional facilitated home-based rehabilitation intervention designed to improve self-care and health-related quality of life in people with HF and their caregivers and to improve access to CR [12].…”

A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: REACH-HFpEF pilot study

“…17 In summary, REACH-HF is a comprehensive self-management programme informed by evidence, theory and service user perspective. It comprises the 'Heart Failure Manual' (REACH-HF manual), relaxation compact disc (CD), chair-based exercise digital versatile disc (DVD), a 'Progress Tracker' tool for patients and a 'Family and Friends Resource' for caregivers.…”